Health Care Homes
Health Care Homes program extended - in December 2018 the Government announced the extension of the Health Care Homes program for an additional eighteen months to 30 June 2021. The period allowed for patient enrolment has also been extended to 30 June 2019, or until enrolment reaches the program’s new patient cap of 12,000.
Information for general practitioners about GP Management Plans (GPMP), Medicare item 721 and Team Care Arrangements (TCAs), Medicare item 723.
1 November 2019
Recently held forum on Cultural change needed to expand healthcare in the home
To inform debate at the forum, the Centre produced an issues paper of the same name that compares hospital treatment with acute and chronic treatment services in the home.
The paper found that, in many cases:
Health Care Homes must contribute to My Health Record
All general practices wanting to take part in the federal government's Health Care Homes trial must be registered for and contribute to the My Health Record. Enrolled patients must also have:
The Department of Health has released details of what will be required of the 200 general practices and Aboriginal community controlled health services (ACCHS) chosen for the first stage of the trial, which has been delivering services since October 2017. Budget 2017.
The model will see primary healthcare retain a fee-for-service model, with top-up funding paid quarterly to support coordination and integration of care – enabling patients with chronic disease to receive integrated care across healthcare settings.
Dr Jones said the medical home would:
'There is strong evidence to prove that patients who have a continuous relationship with their GP and home practice receive higher quality preventive care and have better health outcomes,' Dr Jones said.
Who does this affect?
People with multiple and complex health needs, who may benefit from support by a health care team coordinated by their GP or health service.
Health Care Homes click here
Health Care Homes
03 April 2020
Health Care Homes underway
In an important reform for primary care in Australia, almost 200 Health Care Homes around Australia are enrolling patients. These practices and Aboriginal Community Controlled Health Services (ACCHS) will provide better coordinated and more flexible care for up to 65,000 Australians who are living with chronic and complex health conditions.
By emphasising team-based, coordinated care and better communication, the Health Care Home model can address these issues. Health Care Homes place the patient at the centre of care:
Shared care plan - A central element of the Health Care Home model is a tailored and dynamic shared care plan. During the stage one trial, each Health Care Home patient must have a shared care plan.
Health Care Homes now underway
Over 170 practices and Aboriginal Community Controlled Health Services (ACCHS) around Australia are now providing Health Care Home services to patients with chronic and complex conditions.
The Health Care Home handbook and other resources are available on resources for practices and ACCHS.
16 April 2019
Answering your questions.
03 April 2020
COVID-19 and New Telehealth Items
As part of the COVID-19 National Health Plan, the Government has introduced temporary bulk billed MBS telehealth services for primary care to allow doctors, nurses and mental health professionals to deliver services via telehealth, provided those services are bulk billed. This is a temporary six-month measure.
03 April 2020
There are no limits on how many times a patient can see a doctor and get a Medicare rebate.
Bundled payments
3 April 2020
To enable this new model of care, payments for patients enrolled in Health Care Homes will change. Health Care Homes are paid with a monthly, bundled payment which gives them more flexibility and reduces paperwork.
Each enrolled patient will be registered by the Health Care Home through the Department of Human Services’ (DHS) Health Professionals Online Services (HPOS) system. Regular payments will be made to the practice on a retrospective monthly basis allowing for regular patient review and, if appropriate, adjustment of the patient’s Health Care Home tier level.
There are three levels of payment. The amount paid is linked to each eligible patient’s level of complexity and need, with the highest amount paid for the most complex and high-need patients.
All general practice healthcare associated with a patient’s chronic conditions, previously funded through the MBS, will be funded through the bundled payment.
Enrolled patients can still access fee-for-service billing for care that is not associated with their chronic conditions.
Funding for services provided by allied health professionals and specialists, and for diagnostic and imaging services, are not included in the bundled payment. These services continue to be funded through the MBS. Eligibility for allied health services currently triggered by a GP Management Plan, a Health Assessment for Aboriginal and Torres Strait Islander People or a GP Mental Health Treatment Plan, will be triggered by Health Care Home enrolment.
Consumer Fact Sheets
For more information, go to updates, factsheets and newsletters.
Coordinated care for people with chronic conditions:
More information for consumers is available on the fact sheets and brochures web page.
For health professionals’ information, go to Health Care Homes for health professionals.
3 April 2020
Q. Can I become a Health Care Home patient?
If you
Q. What if I get really sick? Or go to hospital?
If you get really sick, your care team will continue to care for you. They may also work with you to adjust your care plan as needed.
If you go to hospital, the care team will follow up with the hospital.
If you would like to become a Health Care Home patient, ask your GP if their practice is a Health Care Home.
Q. What Happens? Claire's story http://health.gov.au/internet/main/publishing.nsf/Content/health-care-home-claire-story
Stage one Health Care Homes:
Ten Primary Health Network regions have been selected to participate in stage one:
Perth North; Northern Territory; Adelaide; Country South Australia; Western Sydney; Nepean Blue Mountains; Hunter, New England and Central Coast; Brisbane North; South Eastern Melbourne; and Tasmania.
Australian Government: Department of Health
'The Health Care Homes pilot is aimed at patients with chronic disease requiring a high level of support, and will involve up to 200 practices across Australia - from metro to remote communities." The Federal Government's announcement to pilot Health Care Homes in Australia will have life-changing benefits to patients, particularly those with chronic, long-term conditions, according to the Royal Australian College of General Practitioners (RACGP).
RACGP Standards for Patient-Centred Medical Homes
http://www.racgp.org.au/download/Documents/Standards/RACGP-Standards-for-Patient-Centred-Medical-Homes.pdf
published September 2016
The medical home is an approach to providing quality patient care whereby each patient has a stable and ongoing relationship with a general practice that provides continuous and comprehensive care to people at all life stages.
The medical home facilitates a partnership between individual patients, and their personal GP and extended healthcare team, allowing for better-targeted and effective coordination of clinical resources to meet patient needs.
RACGP Vision for general practice and a sustainable healthcare system: A summary
https://www.racgp.org.au/download/Documents/advocacy/Summary-Vision-for-general-practice-and-a-sustainable-healthcare-syst.pdf
The Medical Home model:
The Medical Home Standards align with the five elements of the medical home, which are:
1. Comprehensive care
2. Patient-centred care
3. Coordinated care
4. Accessible services
5. Quality and safety
The Health Care Home:
The Federal Government defines the Health Care Home as an approach where patients living with multiple complex and chronic illnesses enrol with their GP to have their conditions and healthcare needs managed. The Health Care Home is considered a component of the Medical Home.
How it all works...
Creating a formal and regular link between a patient and their GP, Health Care Homes closely aligns with the medical home concept, which has long been called for by the RACGP, and formed the basis of its Vision for general practice and a sustainable healthcare system, launched in September 2015. RACGP President Dr Frank R Jones heralded the move as a 'great win for patients, providers, and funders', and congratulated the Federal Government for listening to the RACGP's calls to implement the medical home model in Australia.
'The Health Care Homes pilot is aimed at patients with chronic disease requiring a high level of support, and will involve up to 200 practices across Australia - from metro to remote communities.
AusHSI academic director professor Nick Graves said healthcare in the home is a priority for the government because of its potential to improve patient flow, meet national emergency access targets and increase capacity within the healthcare system. Graves added: “When you are in hospital there are more opportunities for complex, costly and often unnecessary investigations and treatments to happen.”
Aged Care Insite - 17 February, 2017.
---------------
Australia’s health system faces a range of pressures: an ageing population, an increase in chronic and complex diseases and increasing costs for patients, providers and governments.
To address these pressures, the RACGP developed its Vision for general practice and a sustainable healthcare system (the Vision) which was released on 21 September 2015 at the RACGP’s annual conference GP.
Developed within context of the broader healthcare system, we envisage the Vision will be a catalyst for change. We propose a major overhaul of the current funding system to better support the delivery of quality, sustainable and effective patient healthcare, designed to meet the needs to patients, GPs and governments. The Vision is based on the patient-centred medical home model and is informed by RACGP’s definition of quality general practice.
The Vision forms the basis of the RACGP’s ongoing advocacy strategy for the delivery of quality community based healthcare.
We received feedback from over 1,000 GPs, stakeholders and consumer groups during consultation periods leading up to the finalization of the Vision. We thank the individuals and organisations for their valuable contribution to the Vision during the consultation process.
---------------------
“Central to the reform is the establishment of Health Care Homes, which provide continuity of care, coordinated services and a team based approach according to the needs and wishes of the patient. This new approach is supported by new payment mechanisms to better target available resources to improve patient outcomes."
Key features of the Health Care Home are:
CHF CEO Leanne Wells, who was a member of advisory group, said the government was taking an an ambitious step in reforming the way primary care has been delivered, “traditionally largely by GPs but often with a little support to ensure patients get the overall care they need from other health professionals like nurses, physiotherapists, psychologists, podiatrists and others who are training to provide the right care for people with complex conditions”.
“This has been the great challenge facing Australian health care for the past 30 years – how to reshape Medicare to ensure health services are responsive to the variety of needs imposed by chronic illness and population ageing,” Ms Wells said.
“The reforms offer the prospect of welcome changes that place the patient at the centre of care. Voluntary patient enrolment will provide a clinical ‘home-base’ for the coordination, management and ongoing support for their care.
“It will promote the idea of patients, families and their carers as partners with clinicians in their care, encouraging them to manage their health, aided by technology and with the support of a health care team.
“This will open the way for more avenues to advice and care by telephone, email or videoconferencing, including for after-hours advice or care.”
The PHCAG's 15 recommendations:
plus
Integrated care:
Gold Coast Integrated Care (GCIC) is changing the way patients with chronic conditions are treated on the Gold Coast. The complex program incorporates a multidisciplinary team, from specialist care to allied health and community-based services, across a number of sites supporting patients and their GPs.
GCIC has established partnerships with 14 GP clinics and community-based healthcare providers to facilitate a seamless continuum of care to patients with chronic conditions such as heart disease, chronic obstructive pulmonary disease, kidney disease and diabetes.
Gold Coast Health - Year in review 2015-16.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
My Health Record:
Individuals have a number of mechanisms available to them to manage the content of, and to control access to, their and/or their dependent's My Health Record(s).
These include - Limiting access
Access to the record or documents can be changed to restrict access to information they consider sensitive.
What is in My Health Record?
By default, when an individual registers for a My Health Record they give standing consent for all registered healthcare provider organisations to access and upload information to their My Health Record. Learn more here.
15 March 2021
Health Care Homes program extended - in December 2018 the Government announced the extension of the Health Care Homes program for an additional eighteen months to 30 June 2021. The period allowed for patient enrolment has also been extended to 30 June 2019, or until enrolment reaches the program’s new patient cap of 12,000.
Information for general practitioners about GP Management Plans (GPMP), Medicare item 721 and Team Care Arrangements (TCAs), Medicare item 723.
1 November 2019
Recently held forum on Cultural change needed to expand healthcare in the home
To inform debate at the forum, the Centre produced an issues paper of the same name that compares hospital treatment with acute and chronic treatment services in the home.
The paper found that, in many cases:
- it was better for the patient and
- more cost effective to provide treatment at home than in hospital
- Besides the cost savings
- patients often prefer being at home and
- there can be other benefits
- like a reduced risk of hospital acquired/cross infection
- medication errors and
- decreased patient depression and anxiety
Health Care Homes must contribute to My Health Record
All general practices wanting to take part in the federal government's Health Care Homes trial must be registered for and contribute to the My Health Record. Enrolled patients must also have:
- a My Health Record and
- practices must provide enhanced access for enrolled patients
- through in-hours telephone support,
- or video conferencing
The Department of Health has released details of what will be required of the 200 general practices and Aboriginal community controlled health services (ACCHS) chosen for the first stage of the trial, which has been delivering services since October 2017. Budget 2017.
The model will see primary healthcare retain a fee-for-service model, with top-up funding paid quarterly to support coordination and integration of care – enabling patients with chronic disease to receive integrated care across healthcare settings.
Dr Jones said the medical home would:
- increase access to health services
- decrease use of services used inappropriately (particularly emergency departments and avoidable admissions)
- increase provision of preventive services (eg Cancer Screening)
- improve patient care and experience, and
- reduce health system costs for funders
'There is strong evidence to prove that patients who have a continuous relationship with their GP and home practice receive higher quality preventive care and have better health outcomes,' Dr Jones said.
Who does this affect?
People with multiple and complex health needs, who may benefit from support by a health care team coordinated by their GP or health service.
Health Care Homes click here
Health Care Homes
03 April 2020
Health Care Homes underway
In an important reform for primary care in Australia, almost 200 Health Care Homes around Australia are enrolling patients. These practices and Aboriginal Community Controlled Health Services (ACCHS) will provide better coordinated and more flexible care for up to 65,000 Australians who are living with chronic and complex health conditions.
By emphasising team-based, coordinated care and better communication, the Health Care Home model can address these issues. Health Care Homes place the patient at the centre of care:
Shared care plan - A central element of the Health Care Home model is a tailored and dynamic shared care plan. During the stage one trial, each Health Care Home patient must have a shared care plan.
Health Care Homes now underway
Over 170 practices and Aboriginal Community Controlled Health Services (ACCHS) around Australia are now providing Health Care Home services to patients with chronic and complex conditions.
The Health Care Home handbook and other resources are available on resources for practices and ACCHS.
16 April 2019
Answering your questions.
03 April 2020
COVID-19 and New Telehealth Items
As part of the COVID-19 National Health Plan, the Government has introduced temporary bulk billed MBS telehealth services for primary care to allow doctors, nurses and mental health professionals to deliver services via telehealth, provided those services are bulk billed. This is a temporary six-month measure.
03 April 2020
There are no limits on how many times a patient can see a doctor and get a Medicare rebate.
Bundled payments
3 April 2020
To enable this new model of care, payments for patients enrolled in Health Care Homes will change. Health Care Homes are paid with a monthly, bundled payment which gives them more flexibility and reduces paperwork.
Each enrolled patient will be registered by the Health Care Home through the Department of Human Services’ (DHS) Health Professionals Online Services (HPOS) system. Regular payments will be made to the practice on a retrospective monthly basis allowing for regular patient review and, if appropriate, adjustment of the patient’s Health Care Home tier level.
There are three levels of payment. The amount paid is linked to each eligible patient’s level of complexity and need, with the highest amount paid for the most complex and high-need patients.
All general practice healthcare associated with a patient’s chronic conditions, previously funded through the MBS, will be funded through the bundled payment.
Enrolled patients can still access fee-for-service billing for care that is not associated with their chronic conditions.
Funding for services provided by allied health professionals and specialists, and for diagnostic and imaging services, are not included in the bundled payment. These services continue to be funded through the MBS. Eligibility for allied health services currently triggered by a GP Management Plan, a Health Assessment for Aboriginal and Torres Strait Islander People or a GP Mental Health Treatment Plan, will be triggered by Health Care Home enrolment.
Consumer Fact Sheets
For more information, go to updates, factsheets and newsletters.
Coordinated care for people with chronic conditions:
- y care team — you have a committed care team, led by your usual doctor.
- My shared care plan — with the support of your care team, you will develop a shared care plan. This plan helps you have a greater say in your care; and makes it easier for all the people who look after you, both inside and outside the Health Care Home, to coordinate your care.
- Better access and flexibility — with a care team behind you, you have better access to care. Health Care Homes can also be more responsive and flexible. If you want to talk to someone in your care team, you won’t always need an appointment with your GP. You might call or message the practice team. Or they might call you to see how you’re going.
- Better coordinated — your care team will do more to coordinate all your care from your usual doctor, specialists and other health professionals.
- Chronic medical condition assistance
More information for consumers is available on the fact sheets and brochures web page.
For health professionals’ information, go to Health Care Homes for health professionals.
3 April 2020
Q. Can I become a Health Care Home patient?
If you
- have a Medicare card
- have a My Health Record or are willing to get one
- would benefit from the Health Care Home model of care
- and are assessed as eligible by a participating Health Care Home
Q. What if I get really sick? Or go to hospital?
If you get really sick, your care team will continue to care for you. They may also work with you to adjust your care plan as needed.
If you go to hospital, the care team will follow up with the hospital.
If you would like to become a Health Care Home patient, ask your GP if their practice is a Health Care Home.
Q. What Happens? Claire's story http://health.gov.au/internet/main/publishing.nsf/Content/health-care-home-claire-story
Stage one Health Care Homes:
Ten Primary Health Network regions have been selected to participate in stage one:
Perth North; Northern Territory; Adelaide; Country South Australia; Western Sydney; Nepean Blue Mountains; Hunter, New England and Central Coast; Brisbane North; South Eastern Melbourne; and Tasmania.
Australian Government: Department of Health
'The Health Care Homes pilot is aimed at patients with chronic disease requiring a high level of support, and will involve up to 200 practices across Australia - from metro to remote communities." The Federal Government's announcement to pilot Health Care Homes in Australia will have life-changing benefits to patients, particularly those with chronic, long-term conditions, according to the Royal Australian College of General Practitioners (RACGP).
RACGP Standards for Patient-Centred Medical Homes
http://www.racgp.org.au/download/Documents/Standards/RACGP-Standards-for-Patient-Centred-Medical-Homes.pdf
published September 2016
The medical home is an approach to providing quality patient care whereby each patient has a stable and ongoing relationship with a general practice that provides continuous and comprehensive care to people at all life stages.
The medical home facilitates a partnership between individual patients, and their personal GP and extended healthcare team, allowing for better-targeted and effective coordination of clinical resources to meet patient needs.
RACGP Vision for general practice and a sustainable healthcare system: A summary
https://www.racgp.org.au/download/Documents/advocacy/Summary-Vision-for-general-practice-and-a-sustainable-healthcare-syst.pdf
The Medical Home model:
The Medical Home Standards align with the five elements of the medical home, which are:
1. Comprehensive care
2. Patient-centred care
3. Coordinated care
4. Accessible services
5. Quality and safety
The Health Care Home:
The Federal Government defines the Health Care Home as an approach where patients living with multiple complex and chronic illnesses enrol with their GP to have their conditions and healthcare needs managed. The Health Care Home is considered a component of the Medical Home.
- Medical Home governance
- Patient-centred care
- Coordinated care
- Comprehensive preventive, acute and chronic disease care
- Accessible care
- Safe, high quality care
How it all works...
- The patient’s preferred practitioner should develop a care plan in partnership with the patient (and carer and/ or family, if necessary) and other members of the care team who are responsible for the patient’s care.
- The care plan should outline the patient’s current and long-term needs and goals for care, identify coordination needs, and address potential gaps.
- The care plan should also explain how the patient will reach the goals and who is responsible for implementing each part of the plan (eg the GP, specific members of the care team, or the patient).
- The care plan anticipates routine needs, and tracks current progress towards the patient’s goals.
- The following steps will assist practitioners achieve the outcome:
- • Consult with collaborating providers who will provide a different kind of treatment or service to the patient.
- • Explain the steps involved in the development of the arrangements to the patient, and the patient’s carer (if applicable, if the practitioner considers it appropriate, and if the patient agrees).
- • Discuss with the patient the collaborating providers who will contribute to the development of the plan and provide treatment and services to the patient under those arrangements.
- • Record the patient’s agreement to the preparation and content of the plan.
- • Record the plan in the patient’s record.
- • Give copies of the relevant parts of the plan to the collaborating providers.
- • Offer a copy of the document to the patient and the patient’s carer (if applicable, if the practitioner considers it appropriate, and if the patient agrees).
- Patients and practitioners are required to sign the care plan to indicate that they have discussed and agreed with the content.
- The care plan should be reviewed and updated at regular intervals. The care team will determine when it is relevant to update the care plan.
Creating a formal and regular link between a patient and their GP, Health Care Homes closely aligns with the medical home concept, which has long been called for by the RACGP, and formed the basis of its Vision for general practice and a sustainable healthcare system, launched in September 2015. RACGP President Dr Frank R Jones heralded the move as a 'great win for patients, providers, and funders', and congratulated the Federal Government for listening to the RACGP's calls to implement the medical home model in Australia.
'The Health Care Homes pilot is aimed at patients with chronic disease requiring a high level of support, and will involve up to 200 practices across Australia - from metro to remote communities.
AusHSI academic director professor Nick Graves said healthcare in the home is a priority for the government because of its potential to improve patient flow, meet national emergency access targets and increase capacity within the healthcare system. Graves added: “When you are in hospital there are more opportunities for complex, costly and often unnecessary investigations and treatments to happen.”
Aged Care Insite - 17 February, 2017.
---------------
Australia’s health system faces a range of pressures: an ageing population, an increase in chronic and complex diseases and increasing costs for patients, providers and governments.
To address these pressures, the RACGP developed its Vision for general practice and a sustainable healthcare system (the Vision) which was released on 21 September 2015 at the RACGP’s annual conference GP.
Developed within context of the broader healthcare system, we envisage the Vision will be a catalyst for change. We propose a major overhaul of the current funding system to better support the delivery of quality, sustainable and effective patient healthcare, designed to meet the needs to patients, GPs and governments. The Vision is based on the patient-centred medical home model and is informed by RACGP’s definition of quality general practice.
The Vision forms the basis of the RACGP’s ongoing advocacy strategy for the delivery of quality community based healthcare.
We received feedback from over 1,000 GPs, stakeholders and consumer groups during consultation periods leading up to the finalization of the Vision. We thank the individuals and organisations for their valuable contribution to the Vision during the consultation process.
---------------------
“Central to the reform is the establishment of Health Care Homes, which provide continuity of care, coordinated services and a team based approach according to the needs and wishes of the patient. This new approach is supported by new payment mechanisms to better target available resources to improve patient outcomes."
Key features of the Health Care Home are:
- voluntary patient enrolment with a practice or healthcare provider to provide a clinical ‘home-base’ for the coordination, management and ongoing support for their care.
- Patients, families and their carers as partners in their care where patients are activated to maximise their knowledge, skills and confidence to manage their health, aided by technology and with the support of a health care team.
- Patients have enhanced access to care provided by their Health Care Home in-hours, which may include support by telephone, email or videoconferencing and effective access to after-hours advice or care.
- Patients nominate a preferred clinician who is aware of their problems, priorities and wishes, and is responsible for their care coordination.
- Flexible service delivery and team based care that supports integrated patient care across the continuum of the health system through shared information and care planning.
- A commitment to care which is of high quality and is safe. Care planning and clinical decisions are guided by evidence-based patient health care pathways, appropriate to the patient’s needs.
- Data collection and sharing by patients and their health care teams to measure patient health outcomes and improve performance.
CHF CEO Leanne Wells, who was a member of advisory group, said the government was taking an an ambitious step in reforming the way primary care has been delivered, “traditionally largely by GPs but often with a little support to ensure patients get the overall care they need from other health professionals like nurses, physiotherapists, psychologists, podiatrists and others who are training to provide the right care for people with complex conditions”.
“This has been the great challenge facing Australian health care for the past 30 years – how to reshape Medicare to ensure health services are responsive to the variety of needs imposed by chronic illness and population ageing,” Ms Wells said.
“The reforms offer the prospect of welcome changes that place the patient at the centre of care. Voluntary patient enrolment will provide a clinical ‘home-base’ for the coordination, management and ongoing support for their care.
“It will promote the idea of patients, families and their carers as partners with clinicians in their care, encouraging them to manage their health, aided by technology and with the support of a health care team.
“This will open the way for more avenues to advice and care by telephone, email or videoconferencing, including for after-hours advice or care.”
The PHCAG's 15 recommendations:
- Better targeting of services for patients with chronic and complex conditions in accordance with need by drawing on existing validated Australian and international risk stratification tools to identify patients requiring high levels of coordination and team care
- Establish Health Care Homes
- Activate patients to be engaged in their care, including developing advice on the application of digital health devices and any health system changes required, and enhance access to targeted online patient information and education and self-help resources
- Establish effective mechanisms to support flexible team-based care, including reducing barriers for allied health professionals and community-based specialists accessing and contributing to the My Health Record, and ensuring Health Care Homes use clinical software that is compatible with the Australian digital health infrastructure to support the integration of IT systems
- Enhance regional planning by assessing and sharing the benefits of evidence-based patient healthcare pathway tools that are currently available and being applied in Australia, and requiring PHNs to collaborate with LHNs, PHIs, providers and patients to support regional planning, including the establishment of locally relevant patient health care pathways and admission and discharge protocols
- Maximise the effectiveness of private health insurance investment in the management of chronic conditions, including supporting a single care plan developed by the Health Care Home that better coordinates the provision of all relevant services, whether funded publicly, by PHIs or by patients
- Coordinate care across the health system to improve patient experience, including assessing the applicability of existing care coordination capability in aged care and mental health for inclusion in the Health Care Home planning and patient and family service support
- Support cultural change across the health system by supporting PHNs, professional colleges, associations and consumer groups to develop and implement education and training for healthcare providers and consumers on the development and staged roll-out of the new service delivery and funding models
- Restructure the payment system to support the new approach, including testing upfront and quarterly bundled payments to Health Care Homes to support the new approach prior to wider roll-out and testing new payment models to PHNs to enable them to commission appropriate non-general practice clinical care and coordination services for enrolled patients in their region
- Pursue opportunities for joint and pooled funding by exploring opportunities for state and territory governments, private health insurers and local industries to contribute to the funding base for enrolled populations (through funding or in-kind contribution)
- Patients to contribute to their healthcare costs to the extent that they are able
- Support a quality and continually improving primary health care system by requiring Health Care Home practices to be appropriately accredited or have registered for accreditation, and strengthening the focus of the Practice Incentives Program (PIP) towards quality improvement activities by providing payments to support general practices identifying as Health Care Homes to undertake quality improvement activities in a structured way, informed by data
- Establish a national minimum data set (NMDS) for patients with chronic and complex conditions, with Health Care Homes to provide de-identified data to support an NMDS and exploring IT infrastructure requirements to support the automated extraction of de‑-identified data from clinical software, data analysis and reporting
- Establish new performance reporting arrangements by providing NMDS summary data to practices, regional level data to PHNs and LHNs and build on the existing national reports on chronic disease management to support system improvements and resource allocation
- Integrate evaluation throughout implementation of the reforms through an evaluation framework.
plus
Integrated care:
Gold Coast Integrated Care (GCIC) is changing the way patients with chronic conditions are treated on the Gold Coast. The complex program incorporates a multidisciplinary team, from specialist care to allied health and community-based services, across a number of sites supporting patients and their GPs.
GCIC has established partnerships with 14 GP clinics and community-based healthcare providers to facilitate a seamless continuum of care to patients with chronic conditions such as heart disease, chronic obstructive pulmonary disease, kidney disease and diabetes.
Gold Coast Health - Year in review 2015-16.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
My Health Record:
Individuals have a number of mechanisms available to them to manage the content of, and to control access to, their and/or their dependent's My Health Record(s).
These include - Limiting access
- Limiting access to the whole of their record and having a Record Access Code that needs to be given to healthcare provider organisations who they wish to grant access and/or;
- Limiting access to specific documents in their My Health Record, and having a Document Access Code to give to select healthcare provider organisations for them to gain access to the restricted set of documents;
- Turning off automatic checking for a My Health Record, which will prevent a healthcare provider organisation being automatically notified via their local clinical software if a person has a record.
Access to the record or documents can be changed to restrict access to information they consider sensitive.
What is in My Health Record?
By default, when an individual registers for a My Health Record they give standing consent for all registered healthcare provider organisations to access and upload information to their My Health Record. Learn more here.
15 March 2021